Effectiveness of Care: Nursing Home, Home Health, and Hospice Care

2008 National Healthcare Quality and Disparities Reports

The National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States. It is organized around four dimensions of quality of care: effectiveness, patient safety, timeliness, and patient centeredness.

Nursing Home Care
Long-stay nursing home residents with moderate to severe pain
Long-stay nursing home residents with physical restraints
Long-stay nursing home residents with most of their time spent in bed or in a chair
Long-stay nursing home residents with a urinary tract infection
Long-stay nursing home residents whose depression or anxiety increased
Low-risk, long-stay nursing home residents with loss of control of bowels or bladder
Low-risk, long-stay nursing home residents with a catheter inserted and left in the bladder
High-risk, long-stay nursing home residents with pressure sores
Low-risk, long-stay nursing home residents with pressure sores
Long-stay nursing home residents whose ability to move about in and around their room decreased
Long-stay nursing home residents whose need for help with daily activities increased
Long-stay nursing home residents with too much weight loss
Short-stay nursing home residents with moderate to severe pain
Short-stay nursing home residents with delirium
Short-stay nursing home residents with pressure sores
Long-stay nursing home residents who received influenza vaccination during the flu season
Short-stay nursing home residents who received influenza vaccination during the flu season
Long-stay nursing home residents who were assessed for pneumococcal vaccination
Short-stay nursing home residents who were assessed for pneumococcal vaccination

Home Health Care
Adult home health care patients whose management of oral medications improved
Adult home health care patients whose bathing improved
Adult home health care patients whose ability to get in and out of bed improved
Adult home health care patients whose ability to walk or move around improved
Adult home health care patients whose pain when moving around decreased
Adult home health care patients whose shortness of breath decreased
Adult home health care patients whose urinary incontinence decreased
Adult home health care patients who had to be admitted to the hospital
Adult home health care patients who received urgent, unplanned medical care
Adult home health care patients who stayed at home after an episode of home health care

Hospice Care
Hospice patients who received the right amount of medicine for pain
Hospice patients who received care consistent with their stated end-of-life wishes
Hospice patient caregivers who perceived patient was not referred to hospice at the right time
 


Nursing Home Care

Measure Title

Long-stay nursing home residents with moderate to severe pain.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_1.1 Long-stay nursing home residents who have moderate to severe pain, United States, 2004 and 2006.

9_1_1.2 Long-stay nursing home residents who have moderate to severe pain, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment.

National Numerator

Residents with moderate pain at least daily or horrible or excruciating pain at any frequency on the target assessment.

State Tables

9_1_1.3 Long-stay nursing home residents who have moderate to severe pain, by State, 2002 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Rate is risk adjusted using resident-level covariates.

Excludes admission assessments and assessments with inconsistent or missing responses regarding the measure. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

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Nursing Home Care

Measure Title

Long-stay nursing home residents with physical restraints.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_2.1 Long-stay nursing home residents who were physically restrained, United States, 2004 and 2006.

9_1_2.2 Long-stay nursing home residents who were physically restrained, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment.

National Numerator

Residents who were physically restrained daily on target assessment.

State Tables

9_1_2.3 Long-stay nursing home residents who were physically restrained, by State, 2002 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes admission assessments or residents with missing values. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

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Nursing Home Care

Measure Title

Long-stay nursing home residents with most of their time spent in bed or in a chair.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_3.1 Long-stay nursing home residents who spend most of their time in bed or in a chair, United States, 2004 and 2006.

9_1_3.2 Long-stay nursing home residents who spend most of their time in bed or in a chair, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment.

National Numerator

Residents who were bedfast on target assessment.

State Tables

9_1_3.3 Long-stay nursing home residents who spend most of their time in bed or in a chair, by State, 2002 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes admission assessments, residents with comatose status, or residents with missing values. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

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Nursing Home Care

Measure Title

Long-stay nursing home residents with a urinary tract infection.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_4.1 Long-stay nursing home residents with a urinary tract infection, United States, 2004 and 2006.

9_1_4.2 Long-stay nursing home residents with a urinary tract infection, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment.

National Numerator

Residents with a urinary tract infection on target assessment.

State Tables

9_1_4.3 Long-stay nursing home residents with a urinary tract infection, by State, 2002 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes admission assessments and missing values on the target assessment. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

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Nursing Home Care

Measure Title

Long-stay nursing home residents whose depression or anxiety increased.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_5.1 Long-stay nursing home residents who are more depressed or anxious, United States, 2004 and 2006.

9_1_5.2 Long-stay nursing home residents who are more depressed or anxious, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment and a valid prior assessment.

National Numerator

Residents whose Mood Scale scores are greater on target assessment relative to prior assessment.

State Tables

9_1_5.3 Long-stay nursing home residents who are more depressed or anxious, by State, 2002 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes residents with missing Mood Scale scores on the target assessment or prior assessment, residents who had a maximum Mood Scale score on the prior assessment, or residents who were comatose or comatose status was unknown. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

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Nursing Home Care

Measure Title

Low-risk, long-stay nursing home residents with loss of control of bowels or bladder.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_6.1 Low-risk long-stay nursing home residents who lose control of their bowels or bladder, United States, 2004 and 2006.

9_1_6.2 Low-risk long-stay nursing home residents who lose control of their bowels or bladder, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment and not qualifying as high risk.

National Numerator

Subset of the denominator population who satisfy either of the following conditions: (1) had no pressure sores on the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) 5-day assessment and had at least Stage 1 pressure sores on the SNF PPS 14-day assessment, or (2) had pressure sores on the SNF PPS 5-day assessment, and pressure sores worsened or failed to improve on the SNF PPS 14-day assessment.

State Tables

9_1_6.3 Low-risk long-stay nursing home residents who lose control of their bowels or bladder, by State, 2002 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes admission assessments, residents with missing values, residents with comatose status, residents with an indwelling catheter or ostomy, or residents with unknown status for these conditions. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

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Nursing Home Care

Measure Title

Low-risk, long-stay nursing home residents with a catheter inserted and left in the bladder.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_7.1 Low-risk long-stay nursing home residents with a catheter inserted and left in their bladder, United States, 2004 and 2006.

9_1_7.2 Low-risk long-stay nursing home residents with a catheter inserted and left in their bladder, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment.

National Numerator

Subset of the denominator population with indwelling catheters on target assessment.

State Tables

9_1_7.3 Low-risk long-stay nursing home residents with a catheter inserted and left in their bladder, by State, 2002 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Rate is risk adjusted using resident-level covariates.

Excludes admission assessments or residents with missing values. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

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Nursing Home Care

Measure Title

High-risk, long-stay nursing home residents with pressure sores.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_8.1 High-risk long-stay nursing home residents who have pressure sores, United States, 2004 and 2006.

9_1_8.2 High-risk long-stay nursing home residents who have pressure sores, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment and with any of the following inclusion criteria on the target assessment: impaired in bed mobility or transfer, comatose, or malnourished.

National Numerator

Subset of the denominator population with pressure sores (Stages 1-4) on target assessment.

State Tables

9_1_8.3 High-risk long-stay nursing home residents who have pressure sores, by State, 2002 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Patients with pressure sores at nursing home admission or with missing values are excluded, but their subsequent MDS reassessments are included in the numerator if the sore has not healed.

Excludes facilities with fewer than 30 residents in the denominator. Excludes admission assessments and residents with certain disqualifying responses. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

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Nursing Home Care

Measure Title

Low-risk, long-stay nursing home residents with pressure sores.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_9.1 Low-risk long-stay nursing home residents who have pressure sores, United States, 2004 and 2006.

9_1_9.2 Low-risk long-stay nursing home residents who have pressure sores, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment and not qualifying as high risk.

National Numerator

Subset of the denominator population with pressure sores (Stages 1-4) on target assessment.

State Tables

9_1_9.3 Low-risk long-stay nursing home residents who have pressure sores, by State, 2002 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Patients with pressure sores at nursing home admission or with missing values are excluded, but their subsequent MDS reassessments are included in the numerator if the sore has not healed.

Excludes residents with missing values and residents with comatose status. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

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Nursing Home Care

Measure Title

Long-stay nursing home residents whose ability to move about in and around their room decreased.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_10.1 Long-stay nursing home residents whose ability to move about in and around their room got worse, United States, 2004 and 2006.

9_1_10.2 Long-stay nursing home residents whose ability to move about in and around their room got worse, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment and a valid prior assessment.

National Numerator

Residents whose value for locomotion self-performance is greater at target relative to prior assessment.

State Tables

9_1_10.3 Long-stay nursing home residents whose ability to move about in and around their room got worse, by State, 2002 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Percentage is risk adjusted using resident-level covariates.

Excludes admission assessments; residents with missing values on the target assessment or with “Total dependence,” “Activity did not occur,” or missing values on the prior assessment; residents with comatose status; residents with end-stage disease; residents receiving hospice care; and residents with unknown status for these conditions on the target assessment. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

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Nursing Home Care

Measure Title

Long-stay nursing home residents whose need for help with daily activities increased.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_11.1 Long-stay nursing home residents whose need for help with daily activities has increased, United States, 2004 and 2006.

9_1_11.2 Long-stay nursing home residents whose need for help with daily activities has increased, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment and a valid prior assessment.

National Numerator

Residents with worsening (increasing MDS item score) self-performance in at least one or two of the four Late-Loss Activities of Daily Living (bed mobility, transfers, toilet use, and eating) or at target relative to prior assessment.

State Tables

9_1_11.3 Long-stay nursing home residents whose need for help with daily activities has increased, by State, 2002 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes residents who cannot show decline due to maximum values on target and prior assessments, residents with comatose status, residents with end-stage disease, residents receiving hospice care, and residents with unknown status for these conditions. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

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Nursing Home Care

Measure Title

Long-stay nursing home residents with too much weight loss.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_12.1 Long-stay nursing home residents who lose too much weight, United States, 2004 and 2006.

9_1_12.2 Long-stay nursing home residents who lose too much weight, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment and a valid prior assessment.

National Numerator

Residents who have experienced weight loss of 5 percent or more in the last 30 days or 10 percent or more in the last 6 months.

State Tables

9_1_12.3 Long-stay nursing home residents who lose too much weight, by State, 2004 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes admission assessments, residents with missing weight loss data, and residents receiving hospice care. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

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Nursing Home Care

Measure Title

Short-stay nursing home residents with moderate to severe pain.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_13.1 Short-stay nursing home residents who had moderate to severe pain, United States, 2004 and 2006.

9_1_13.2 Short-stay nursing home residents who had moderate to severe pain, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary post-acute care patients with a valid Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) 14-day assessment.

National Numerator

Subset of the denominator population with moderate pain at least daily or horrible or excruciating pain at any frequency.

State Tables

9_1_13.3 Short-stay nursing home residents who had moderate to severe pain, by State, 2002 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes assessments with inconsistent responses regarding the measure. Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

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Nursing Home Care

Measure Title

Short-stay nursing home residents with delirium.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_14.1 Short-stay nursing home residents with delirium, United States, 2004 and 2006.

9_1_14.2 Short-stay nursing home residents with delirium, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary post-acute care patients with a valid Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) 14-day assessment.

National Numerator

Subset of the denominator population with at least one symptom of delirium that represents a departure from usual functioning.

State Tables

9_1_14.3 Short-stay nursing home residents with delirium, by State, 2002 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Percentage is risk adjusted using resident-level covariates.

Excludes residents with comatose status, residents with end-stage disease, residents receiving hospice care, and residents with unknown status for these conditions. Residents with neurodegenerative diseases are not automatically excluded.

Excludes facilities with fewer than 30 residents in the denominator. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

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Nursing Home Care

Measure Title

Short-stay nursing home residents with pressure sores.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_15.1 Short-stay nursing home residents with pressure sores, United States, 2004 and 2006.

9_1_15.2 Short-stay nursing home residents with pressure sores, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary post-acute care patients with a valid Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) 14-day assessment and a valid preceding SNF PPS 5-day assessment.

National Numerator

Subset of the denominator population who satisfy either of the following conditions: (1) had no pressure sores on the SNF PPS 5-day assessment and had at least Stage 1 pressure sores on the SNF PPS 14-day assessment, or (2) had pressure sores on the SNF PPS 5-day assessment, and pressure sores worsened or failed to improve on the SNF PPS 14-day assessment.

State Tables

9_1_15.3 Short-stay nursing home residents with pressure sores, by State, 2002 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Percentage is risk adjusted using resident-level covariates.

Excludes facilities with fewer than 30 residents in the denominator and patients with missing values. For details about this and other measures of the Nursing Home Quality Initiative, please refer to the documentation available at http://www.cms.hhs.gov/NursingHomeQualityInits/.

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Nursing Home Care

Measure Title

Long-stay nursing home residents who received influenza vaccination during the flu season.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_16.1 Long-stay nursing home residents given influenza vaccination during the flu season, United States, 2006.

9_1_16.2 Long-stay nursing home residents given influenza vaccination during the flu season, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents during the most recently completed influenza season with a valid target assessment in effect during any part of the season.

National Numerator

Residents who received an influenza vaccine during the most recently completed influenza season.

State Tables

9_1_16.3 Long-stay nursing home residents given influenza vaccination during the flu season, by State, 2006 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes residents ineligible for the influenza vaccine, residents who were offered the vaccine but declined, and residents in facilities unable to obtain the vaccine.

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Nursing Home Care

Measure Title

Short-stay nursing home residents who received influenza vaccination during the flu season.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_17.1 Short-stay nursing home residents given influenza vaccination during the flu season, United States, 2006.

9_1_17.2 Short-stay nursing home residents given influenza vaccination during the flu season, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Short-stay residents during the most recently completed influenza season with a valid target assessment in effect during any part of the season.

National Numerator

Subset of the denominator who received an influenza vaccine during the most recently completed influenza season.

State Tables

9_1_17.3 Short-stay nursing home residents given influenza vaccination during the flu season, by State, 2006 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes residents ineligible for the influenza vaccine, residents who were offered the vaccine but declined, and residents in facilities unable to obtain the vaccine.

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Nursing Home Care

Measure Title

Long-stay nursing home residents who were assessed for pneumococcal vaccination.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_18.1 Long-stay nursing home residents who were assessed and given pneumococcal vaccination, United States, 2006.

9_1_18.2 Long-stay nursing home residents who were assessed and given pneumococcal vaccination, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Medicare beneficiary chronic care residents with a valid target assessment within the 6-month target period.

National Numerator

Residents who have an up-to-date pneumococcal vaccination.

State Tables

9_1_18.3 Long-stay nursing home residents who were assessed and given pneumococcal vaccination, by State, 2006 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes residents ineligible for the pneumococcal vaccine and residents who were offered the vaccine but declined.

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Nursing Home Care

Measure Title

Short-stay nursing home residents who were assessed for pneumococcal vaccination.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Quality Initiative.

National Tables

9_1_19.1 Short-stay nursing home residents who were assessed and given pneumococcal vaccination, United States, 2006.

9_1_19.2 Short-stay nursing home residents who were assessed and given pneumococcal vaccination, United States, 2006, by:

  • Race/ethnicity.

National Data Source

CMS, Nursing Home Minimum Data Set (MDS).

National Denominator

Short-stay residents with a valid target assessment within the 6-month target period.

National Numerator

Subset of the denominator who have an up-to-date pneumococcal vaccination.

State Tables

9_1_19.3 Short-stay nursing home residents who were assessed and given pneumococcal vaccination, by State, 2006 and 2007.

State Data Source

CMS, MDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Excludes residents ineligible for the pneumococcal vaccine and residents who were offered the vaccine but declined.

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Home Health Care

Measure Title

Adult home health care patients whose management of oral medications improved.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

9_2_1.1 Home health care patients who get better at taking their medication correctly, United States, 2004 and 2006.

9_2_1.2 Home health care patients who get better at taking their medication correctly, United States, 2006, by:

  • Race.
  • Ethnicity.

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes in which a person showed improvement in ability to manage oral medications compared with a prior assessment.

State Tables

9_2_1.3 Home health care patients who get better at taking their medicines correctly (by mouth), by State, 2005 and 2007.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The OASIS instrument measures management of oral medications on a 3-level scale from 0 (fully independent) to 2 (entirely dependent) and refers to ability, not medication compliance. Episodes are not included for people who are at the highest level and cannot improve any further.

Excludes injectable and IV medications.

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

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Home Health Care

Measure Title

Adult home health care patients whose bathing improved.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

9_2_2.1 Home health care patients who get better at bathing, United States, 2004 and 2006.

9_2_2.2 Home health care patients who get better at bathing, United States, 2006, by:

  • Race.
  • Ethnicity.

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes in which a person's ability to bathe improved compared with a prior assessment.

State Tables

9_2_2.3 Home health care patients who get better at bathing, by State, 2005 and 2007.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The OASIS instrument measures bathing ability on a 6-level scale from 0 (fully independent) to 5 (completely dependent). Episodes are not included for people who are at the highest level and cannot improve any further.

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

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Home Health Care

Measure Title

Adult home health care patients whose ability to get in and out of bed improved.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

9_2_3.1 Home health care patients who get better at getting in and out of bed, United States, 2004 and 2006.

9_2_3.2 Home health care patients who get better at getting in and out of bed, United States, 2006, by:

  • Race.
  • Ethnicity.

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes in which a person improved at getting in and out of bed compared with a prior assessment.

State Tables

9_2_3.3 Home health care patients who get better at getting in and out of bed, by State, 2005 and 2007.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The OASIS instrument measures transferring on a 6-level scale from 0 (independent) to 5 (bedfast and unable to turn or position). Episodes are not included for people who are at the highest level and cannot improve any further.

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

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Home Health Care

Measure Title

Adult home health care patients whose ability to walk or move around improved.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

9_2_4.1 Home health care patients who get better at walking or moving around, United States, 2004 and 2006.

9_2_4.2 Home health care patients who get better at walking or moving around, United States, 2006, by:

  • Race.
  • Ethnicity.

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes in which a person improved at walking or moving around compared with a prior assessment.

State Tables

9_2_4.3 Home health care patients who get better at walking or moving around, by State, 2005 and 2007.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The OASIS instrument measures ambulation or locomotion ability on a 6-level scale from 0 (full, independent ambulation) to 5 (bedfast). Episodes are not included for people who are at the highest level and cannot improve any further.

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

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Home Health Care

Measure Title

Adult home health care patients whose pain when moving around decreased.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

9_2_5.1 Home health care patients who have less pain when moving around, United States, 2004 and 2006.

9_2_5.2 Home health care patients who have less pain when moving around, United States, 2006, by:

  • Race.
  • Ethnicity.

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes in which a person's frequency of pain interfering with activity or movement improved compared with a prior assessment.

State Tables

9_2_5.3 Home health care patients who have less pain when moving around, by State, 2005 and 2007.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The OASIS instrument measures frequency of pain on a 4-level scale from 0 (no pain or pain does not interfere with activity) to 3 (constant). Episodes are not included for people who are at the highest level and cannot improve any further.

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

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Home Health Care

Measure Title

Adult home health care patients whose shortness of breath decreased.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

9_2_6.1 Home health care patients who have less shortness of breath, United States, 2004 and 2006.

9_2_6.2 Home health care patients who have less shortness of breath, United States, 2006, by:

  • Race.
  • Ethnicity.

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes in which a person's dyspneic status improved compared with a prior assessment.

State Tables

9_2_6.3 Home health care patients who are short of breath less often, by State, 2005 and 2007.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The OASIS instrument measures dyspneic status on a 4-level scale from 0 (never short of breath) to 3 (dyspnea at rest). Episodes are not included for people who are at the highest level and cannot improve any further.

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

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Home Health Care

Measure Title

Adult home health care patients whose urinary incontinence decreased.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

9_2_7.1 Home health care patients who have less urinary incontinence, United States, 2004 and 2006.

9_2_7.2 Home health care patients who have less urinary incontinence, United States, 2006, by:

  • Race.
  • Ethnicity.

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes in which a person's urinary incontinence status improved compared with a prior assessment.

State Tables

9_2_7.3 Home health care patients whose bladder control improves, by State, 2005 and 2007.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Episodes are not included for people who are at the highest level and cannot improve any further.

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

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Home Health Care

Measure Title

Adult home health care patients who had to be admitted to the hospital.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

9_2_8.1 Home health care patients who had to be admitted to the hospital, United States, 2004 and 2006.

9_2_8.2 Home health care patients who had to be admitted to the hospital, United States, 2006, by:

  • Race.
  • Ethnicity.

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes in which a person was hospitalized for an acute condition while receiving home health care services.

State Tables

9_2_8.3 Home health care patients who had to be admitted to the hospital, by State, 2005 and 2007.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Hospitalization may be for emergent, urgent, or elective conditions.

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

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Home Health Care

Measure Title

Adult home health care patients who received urgent, unplanned medical care.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

9_2_9.1 Home health care patients who need urgent, unplanned medical care, United States, 2004 and 2006.

9_2_9.2 Home health care patients who need urgent, unplanned medical care, United States, 2006, by:

  • Race.
  • Ethnicity.

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes with an assessment indicating that urgent or unplanned medical care was initiated.

State Tables

9_2_9.3 Home health care patients who need urgent, unplanned medical care, by State, 2005 and 2007.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

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Home Health Care

Measure Title

Adult home health care patients who stayed at home after an episode of home health care.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Quality Initiative.

National Tables

9_2_10.1 Home health care patients who stayed at home after an episode of home health care ended, United States, 2004 and 2006.

9_2_10.2 Home health care patients who stay at home after an episode of home health care ends, United States, 2006, by:

  • Race.
  • Ethnicity.

National Data Source

CMS, Home Health Outcome and Assessment Information Set (OASIS).

National Denominator

All home health care episodes that begin and end in the survey year.

National Numerator

Episodes with final assessments indicating that patients remained at home at the conclusion of services.

State Tables

9_2_10.3 Home health care patients who stay at home after an episode of home health care ends, by State, 2005 and 2007.

State Data Source

CMS, OASIS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Risk-adjusted rates are available for State estimates only. Particulars about risk adjustment and further information about this and other measures of the Home Health Quality Initiative are available at http://www.cms.hhs.gov/HomeHealthQualityInits/.

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Hospice Care

Measure Title

Hospice patients who received the right amount of medicine for pain.

Measure Source

National Hospice and Palliative Care Organization (NHPCO).

National Tables

9_3_1.1 Hospice patients who received the right amount of medicine for pain, United States, 2005 and 2007.

National Data Source

Centers for Medicare & Medicaid Services (CMS), NHPCO, Family Evaluation of Hospice Care Survey (FEHCS).

National Denominator

Hospice patients age 18 and over.

National Numerator

Subset of the denominator who received the right amount of medicine for pain, according to the survey respondent.

State Tables

9_3_1.2 Hospice patients who received the right amount of medicine for pain, by State, 2006 and 2007.

State Data Source

CMS, NHPCO, FEHCS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The FEHCS is administered to family members of deceased recipients of hospice care. See the Data Sources appendix for further information.

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Hospice Care

Measure Title

Hospice patients who received care consistent with their stated end-of-life wishes.

Measure Source

National Hospice and Palliative Care Organization (NHPCO).

National Tables

9_3_2.1 Hospice patients who received care consistent with their stated end-of-life wishes, United States, 2005 and 2007.

National Data Source

Centers for Medicare & Medicaid Services (CMS), NHPCO, Family Evaluation of Hospice Care Survey (FEHCS).

National Denominator

Hospice patients age 18 and over.

National Numerator

Subset of the denominator who received care consistent with their stated end of life wishes, according to the survey respondent.

State Tables

9_3_2.2 Hospice patients who received care consistent with their stated end-of-life wishes, by State, 2006 and 2007.

State Data Source

CMS, NHPCO, FEHCS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The FEHCS is administered to family members of deceased recipients of hospice care. See the Data Sources appendix for further information.

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Hospice Care

Measure Title

Hospice patient caregivers who perceived patient was not referred to hospice at the right time.

Measure Source

National Hospice and Palliative Care Organization (NHPCO).

National Tables

9_3_3.1 Hospice patient caregivers who perceived patient was referred to hospice at the right time, United States, 2007.

National Data Source

Centers for Medicare & Medicaid Services (CMS), NHPCO, Family Evaluation of Hospice Care Survey (FEHCS).

National Denominator

Hospice patients age 18 and over.

National Numerator

Subset of the denominator for whom the survey respondent indicated that the patient was referred to hospice at the right time.

State Tables

9_3_3.2 Hospice patient caregivers who perceived patient was referred to hospice at the right time, by State, 2007.

State Data Source

CMS, NHPCO, FEHCS.

State Denominator

Same as national.

State Numerator

Same as national.

Return to Measure Specifications

Current as of September 2009
Internet Citation: Effectiveness of Care: Nursing Home, Home Health, and Hospice Care: 2008 National Healthcare Quality and Disparities Reports. September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr08/measurespec/nursing_home_home_health_and_hospice_care.html